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Repeat Vasectomy Reversal Effective After Prior Failures

Am Fam Physician. 1999 Jun 1;59(11):3191-3192.

With over 500,000 procedures performed annually, vasectomy is one of the most common surgical procedures in the United States. Although it is largely considered a permanent procedure, a few patients request a reversal. Microsurgical reversals have proved to be highly successful; however, up to 30 percent of reversals fail to reestablish sperm ejaculate. Hernandez and Sabanegh studied the success rate of vasectomy reversals after one or more failed attempts.

The authors reviewed the cases of 41 men who underwent vasectomy reversal again after one or more attempts at reversal had failed. The same surgeon performed these microsurgical reversal procedures. The data reviewed included date of vasectomy and first reversal attempt, history of prior conception with current partner, history of female infertility factors and smoking status. Semen analysis was performed three months after the procedure and quarterly for up to one year. Both patient and partner were interviewed during follow-up to determine post-procedure pregnancy rates. The mean follow-up period was eight months.

Thirty-eight of the men had undergone one prior reversal attempt and three had undergone two prior procedures. The mean age of the men was 39. A mean of 10.6 years had elapsed between the original vasectomy and the study procedure. Seventy-three percent of the men required vasoepididymostomy on at least one side during the reversal procedure, whereas only 4 percent of men undergoing initial reversal required vasoepididymostomy.

The postprocedure patency rate was 79 percent, with a pregnancy rate of 31 percent. The mean total motile sperm count after the procedure was 38 million. The only factor predictive of future conception was prior conception with the same partner; 80 percent of these men initiated a pregnancy, compared with 17 percent of men who had not previously conceived with their partner.

Even in experienced hands, vasectomy reversal may fail. Microsurgery after a failed vasectomy reversal can restore patency levels at rates consistent with those for the original procedure. The pregnancy rate was slightly lower than that for other studies, but the authors attributed this to the short length of follow-up. The authors conclude that micro-surgical reversal of vasectomies after one or more failed attempts is associated with high patency rates and moderate pregnancy rates.